Finding the Way to a Career in Science

Q: Talk a little bit about your background. Where did you grow up?

Dr. Maddox: I came from a small rural town in New Kent County, Virginia, which is about 20 miles southeast of Richmond. It was definitely very rural. You can go 20 miles outside of Richmond and you're in "no-man's land," as we say, but I really always knew that I wanted to be in the sciences.

It was because I had great elementary and middle school and high school teachers. They saw something in me that suggested that I could be focused in a scientific area, and I wanted to go to medical school to be a physician. So I had to major in biology or biochemistry or a related field to head in that direction.

Q: So you went to Virginia Union University, but after graduation you had to give up your spot in medical school because your father died. What happened next?

I found a job as a blood bank technician, a 3-month summer job, at the Medical College of Virginia in Richmond. At the end of the 3 months, the woman who was the director of the blood bank said she knew a researcher, Dr. Sami Said, who had a laboratory in the hospital. His technician was leaving. So she said, "Let me call one of my colleagues who knows him and see what we can arrange."

At the time, Dr. Said was at the Karolinska Institute in Sweden and studying vasoactive intestinal polypeptide. In fact, he was the co-discoverer of that peptide. She called Dr. Said and recommended me.

Q: Being mentored first by Dr. Said and later by Dr. Peter Ramwell at Georgetown gave your career a real lift. With Dr. Said, your first publication was in the journal Science,1 and with Dr. Ramwell, your second paper was in Nature.2 Were you aware of how impressive that was?

I never knew what it meant, because, keep in mind, I hadn't even gotten my Ph.D. then. But later on in life as people began to interview me and to introduce me at speaking engagements, they would say, "Dr. Maddox is not only a pretty good researcher"—and then they would smile—"Her first paper was in Science. Her second paper was in Nature."

It really was a wonderful opportunity, and the reason I put this out there—and many of my colleagues here at NIH have heard this before—it is definitely the nurturing and the mentoring and the care that others give you when you're starting out in your career that can help you become successful and can assist you with your career development.

Building an NIH Career

Q: When did you first come to NIH?

I actually came to NIH in 1985. I was recruited to run the program in trauma and burn injury in the NIGMS. That program was focused on mediators of injury—cytokines, arachidonic products, eicosanoids. So when I came to NIGMS and took over that portfolio, it was a portfolio that I knew. It was close to my own training in physiology.

I was recruited from Georgetown University Medical Center, where I was a research assistant professor and had a laboratory. But I wanted to do more in the way of public policy and health policy. When the offer came to come to the NIH, I was very excited about it, although I had some concerns about leaving the bench because I was a bench researcher. But it looked like a good opportunity for me to do the public health that I had wanted to do for so long.

Q: Speaking of your mentors, Dr. Ruth Kirschstein, who died in 2009, was a pioneer in science and at the NIH. What was she like to work with?

Ruth was the first woman Director of an Institute at NIH when she became Director of NIGMS. She took me under her wing and was truly a mentor for me and a tremendous role model. She dedicated her life to NIH. She also lived on campus so she could be on the job all the time, really.

Ruth told me early on that in order to get people to work with you and to be a force—not only a powerful force but a force that people enjoyed working with—you really had to be someone that they trusted and respected.

Q: You have a reputation for being "a force" in your own right and having good interpersonal skills. Did your family help nurture that?

My mom sold Avon and, in spite of being a low-income family, she was able to give us the right direction and lead us in the right direction. She just exuded compassion and excitement about life and joy and happiness. I rarely saw her grouchy or, you know, even when she was angry with us she kind of said it in this profound "you must listen" way, but it wasn't mean-spirited. She really did smile a lot. Even when I knew times weren't good, there was joy in her heart. That made me better.

Milestones in Infant, Child, and Maternal Health

Q: You've worked a lot on infant mortality during your time with the NICHD. Is this a major problem in the United States?

When you think about the infant mortality rate in this country today—six per 1,000 live births—that means for every 1,000 children who are born, six die. You know, that's pretty discouraging when you think about us as a developed country. Then when you look at some of the other developed countries, you know, we rank about 24 or 25, so we're not where we should be.

In the African-American community, the infant mortality rate is twice as high as in the general population. Native Americans—their infant mortality rate is three times that and even in some tribes four times the national norm.

So we have worked very hard to get the facts out about infant mortality, but also we've been working on ways in which we can curb it and ways in which we can reduce it and ultimately eliminate the disparity that we see.

Q: Your name has been associated with the founding of the NICHD's Office of Global Health. Was that a priority for you?

When I came to the NICHD in 1995, we had several international programs that were ongoing, particularly in the area of contraception. We were doing a little bit on HIV/AIDS, particularly as it relates to mother-to-child transmission. But the Institute didn't have much in the way of international efforts on things like birth defects or poor nutrition. The international program was something that I knew least about, but I really wanted to take it on.

Q: Intellectual and developmental disabilities have always been a major part of the NICHD mission since it was established in 1962. You've worked to continue that mission. How?

I really feel that some of the conditions that fall under the definition of intellectual and developmental disabilities have not been addressed with the research background necessary to better explain the condition and to give us some sense of how to care for individuals with the condition.

We had done very well, I thought, in getting a portfolio with autism established—even a portfolio on Fragile X syndrome. But I don't think we'd done nearly as much as we should have done with Down syndrome. Recently, we established the Down syndrome registry, DS-Connect®, to allow researchers to find people with Down syndrome that can lead to new therapies for these individuals.

Creating an Impact on People's Lives

Q: Do you ever stop to reflect on how your work has changed lives?

I don't know so much about my impacting people as people impacting me. I have moments of thinking about the young child with Down syndrome or a developmental disability who goes off to school and is bullied, or who encounters children who don't fully understand the disability, and the child comes home crying. I hear these stories frequently. Those are the types of personal interactions that I have with people because people email me. I get an email every day, without fail, from someone out in the field who I've gotten a chance to meet.

In my office, I have so many pictures of children that families have sent me as they've grown through the years. I've met them when they were toddlers, and now they're in college. So yes, that has meant a lot to me, but I have to say that's what kept me going.

Life On and Off the Job

Q: What sorts of things do you do outside of work?

I love running. I'm a jogger, and I do it faithfully. I've run several marathons, and it really does keep my brain maybe alert and active. I enjoy skiing, but I don't do much of that anymore. I'm fearful that with aging I'm going to break some of my bones and not be able to repair them as quickly.

I also really love my church. I seldom miss a Sunday if I'm in town. My husband and I both have spent a lot of time on the various church boards. I have been an elder, and it's a real responsibility that I take very seriously. I am chair of the women's fellowship, so I'm always looking at ways in which I can advance women in the church and make women who are part of our congregation feel that they are valued and valuable.

I think all of those activities that are representative of what I do on the outside also feed me in such a way that I can come here every day and hopefully treat people fairly and with dignity.

Q: Have you managed to achieve a good balance of work and life?

My life was the job, but I don't think my job was all that I am. I think that I brought all of the traits that I exude into the job, such that the job really was me in a real sense. It really was a wonderful opportunity here for me to be the person I wanted to be and the person I've become.

Obviously, I've loved my tenure here. I don't believe that anyone could take on a job like this or a position like this and stay as long as I have if you didn't enjoy it. So it was a wonderful time for me within the Institute as well as being within the NIH.

Q: What will you miss the least after you leave the NICHD?

Getting up at 4:30 in the morning to get out of the house by 5:30 to be here to beat the traffic. All jokes aside, I think the real challenges are having to do these balancing acts that we have to do in times of short funding. I also think that the challenge in making decisions that are timely and impactful and that benefit all of the players is a tough thing to do because you want to make good decisions. Oftentimes a good decision may be not so good for one person but tremendously valuable to another. So those challenges are the things that have kept me up at night, trying to make good decisions and making them in a timely manner.

A final note: Dr. Maddox will continue commuting for a while longer. On April 1, 2014, she left the NICHD to take over as Acting Director of the NIMHD. She will remain at that post until a permanent Director is found. After that, Dr. Maddox will establish a family foundation to continue to work on the issues related to children and families that she focused on at the NICHD.

The seed money for that foundation comes from a modest legacy her mother, Thomasine Thornton Thompson, left her.